Duovir (Lamivudine & Zidovudine)

DESCRIPTION

Duovir belongs to the classification of antiretroviral drugs which associates to nucleoside polymerase. Duovir is an combination drugs of lamivudine 150mg and Zidovudine 300mg.

INDICATION

Duovir is indicated for the treatment of HIV-1 infection by combination with other antiretrovirals drugs. Duovir which is belongs to nucleoside analogue with co administration of lamivudine and zidovudine.

MECHANISM OF ACTION

Duovir (Lamivudine and zidovudine) belongs to a synthetic nucleoside analogue. Both drugs acts like inside cell Lamivudine (Duovir) and Zidovudine (Duovir) is phosphorylated to its active 5-triphosphate metabolite and forms Zidovudine (Duovir) triphosphate and Lamivudine (Duovir) triphosphate (L-TP). The basic action of L-TP and ZDV-TP is inhibition of reverse transcriptase (RT) via DNA chain termination after incorporation of the nucleoside correlated.Both L-TP and ZDV-TP is a weak inhibitor of mammalian DNA polymerases a and b, and mitochondrial DNA polymerase g which has been reported to be incorporated into DNA of cells in culture.

ADME PROPERTIES

ABSORPTION

Fastly absorbed from the GI tract. Absorption with food is delayed Bioavailability: 80-87% (lamivudine); approx 60-70% (zidovudine). Time to peak plasma concentration: Approx 1 hr.

DISTRIBUTION

the drug Passes via blood-brain barrier and placenta which enters breast milk and Detected in semen (zidovudine). Volume of distribution: 1.3 L/kg (lamivudine); 1-2.2 L/kg (zidovudine). Human Plasma protein bounding is 36% (lamivudine); 34-38% (zidovudine).

METABOLISM

Both the drugs which are metabolized intercellular to form the active triphosphate . Zidovudine go via hepatic metabolism, mainly to the inactive glucuronide.

EXCRETION

Lamiudine and zidovudine excreted Via urine, (mainly as unchanged drug) Elimination half-life: 5-7 hr (lamivudine); 0.5-3 hr (zidovudine).

DOSAGE MANAGEMENT

Duovir dosage in adults is lamivudine 150mg and zidovudine 300mg with weight of >30kg one tablet twice in a day children of 14-21 kg one half tablet bid and for 22-30kg one half tablet in the morning or one half tab tid. Duovir may be taken with or without food.

SIDE EFFECTS
If any of these side effects occurs while taking Duovir , you should consult with doctor urgently. More common side effects Head pain, Chills, fever, pale skin, sore throat weakness, Less common side effects Stomach ache, nausea, skin rash, vomiting, yellow eyes, coughing, loss of appetite, difficult in sleeping Incident not known: Blurred vision, dry mouth, hair loss, increased (hunger, thirst, urination), chest discomfort, wheezing, myalgia, convulsions.

PRECAUTION

The women having Obese with hepatomegaly, hepatitis or other risk factors causes liver disease and hepatic steatosis; hepatitis B or C virus co-infection leads risk factors for pancreatitis Patient with poor bone marrow reserve before the treatment. Renal and severe hepatic impairment. Childern Pregnancy.

Monitoring Parameters :Monitor haematological parameters observe for appearance of hardened infections and signs and symptoms of pancreatitis. Continually monitor hepatic function test and for several month following discontinuation of therapy for patients co-infected with hepatitis B virus and HIV.

DRUG INTERACTION

Duovir given with Emtricitabine may develop cross –resistance. Continue use of Zidovudine with Ribavirin leads to Excerabtion of anemia. Lamivudine and Zalcitabine may prevent intracellularily phosphorylation of one another.

Interaction of Zidovudine with Stavudine and doxorubicin will produce antagonistic effects. Duovir used with interferon alfa in HIV may develop risk of hepatic decompenstion.

CONTRAINDICATIONS

Previously demonstrating clinically significant in patients are hypersensitivity to any of the component of Duovir. The patient with low body weight should not be receiving Duovir dose.

PREGNANCY

Category C: Animal reproduction studies have shown adverse effect on fetus while in human there are no sufficient and well tolerated studies, but possible use may warrant the in drug in pregnant women produce possible risk.

STORAGE

The drug stored at 2-30°C Store in cool and dry place and keep away from children and lights. Duovir should be used before expiry date.

MISSED DOSE

If a dose is missed by the patient then have the dose as soon as possible or skip the medicine and follow regular schedule. Please consult with the doctor